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Comparison Between In-Person and Audio-Only Virtual Prenatal Visits and Perinatal Outcomes

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Were audio-only virtual prenatal visits during the COVID-19 pandemic associated with a change in perinatal outcomes in a vulnerable population?

Findings  In this cohort study of 12 607 women, 173 women (2.9%) experienced placental abruption, stillbirth, cord pH less than 7.0, or full-term neonatal intensive care unit admission, which was not significantly different than the 195 women (3.0%) affected in 2019. The rate of this composite outcome also did not differ significantly when stratified by the number of virtual prenatal visits.

Meaning  In this study, women who delivered in 2020 following implementation of audio-only prenatal virtual visits did not experience more adverse pregnancy outcomes than women who delivered in 2019.

Abstract

Importance  Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology.

Objective  To explore the association of audio-only virtual prenatal care with perinatal outcomes.

Design, Setting, and Participants  This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included.

Exposures  Prenatal care incorporating audio-only prenatal care visits.

Main Outcomes and Measures  The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined.

Results  The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended.

Conclusions and Relevance  Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: February 23, 2021.

Published: April 14, 2021. doi:10.1001/jamanetworkopen.2021.5854

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Duryea EL et al. JAMA Network Open.

Corresponding Author: Elaine L. Duryea, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 (elaine.duryea@utsouthwestern.edu).

Author Contributions: Drs Duryea and McIntire had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Duryea, Ambia, Spong, McIntire, Nelson.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Duryea, McIntire, Nelson.

Administrative, technical, or material support: Duryea, Spong.

Supervision: Duryea, Adhikari, Spong, Nelson.

Conflict of Interest Disclosures: None reported.

Funding/Support: Internal funding from the academic department of Obstetrics and Gynecology at University of Texas Southwestern supported this study.

Role of the Funder/Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Ozimek  JA , Kilpatrick  SJ .  Maternal mortality in the twenty-first century.   Obstet Gynecol Clin North Am. 2018;45(2):175-186. doi:10.1016/j.ogc.2018.01.004 PubMedGoogle ScholarCrossref
2.
Xu  J , Kochanek  KD , Murphy  SL , Tejada-Vera  B .  Deaths: final data for 2007.   Natl Vital Stat Rep. 2010;58(19):1-19.PubMedGoogle Scholar
3.
Berg  CJ , Callaghan  WM , Syverson  C , Henderson  Z .  Pregnancy-related mortality in the United States, 1998 to 2005.   Obstet Gynecol. 2010;116(6):1302-1309. doi:10.1097/AOG.0b013e3181fdfb11 PubMedGoogle ScholarCrossref
4.
Partridge  S , Balayla  J , Holcroft  CA , Abenhaim  HA .  Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 US deliveries over 8 years.   Am J Perinatol. 2012;29(10):787-793. doi:10.1055/s-0032-1316439 PubMedGoogle ScholarCrossref
5.
Leveno  KJ , McIntire  DD , Bloom  SL , Sibley  MR , Anderson  RJ .  Decreased preterm births in an inner-city public hospital.   Obstet Gynecol. 2009;113(3):578-584. doi:10.1097/AOG.0b013e318195e257 PubMedGoogle ScholarCrossref
6.
Osterman  MJK , Martin  JA . Timing and adequacy of prenatal care in the United States, 2016. National Vital Statistics Reports. Vol 67, no 3. National Center for Health Statistics; 2018.
7.
Petersen  EE , Davis  NL , Goodman  D ,  et al.  Racial/ethnic disparities in pregnancy-related deaths—United States, 2007-2016.   MMWR Morb Mortal Wkly Rep. 2019;68(35):762-765. doi:10.15585/mmwr.mm6835a3 PubMedGoogle ScholarCrossref
8.
House Committee on Energy & Commerce. Hearing on “Improving maternal health: legislation to advance prevention efforts and access to care.” Published September 20, 2019. Accessed March 10, 2021. https://energycommerce.house.gov/committee-activity/hearings/hearing-on-improving-maternal-health-legislation-to-advance-prevention
9.
Onwuzurike  C , Meadows  AR , Nour  NM .  Examining inequities associated with changes in obstetric and gynecologic care delivery during the coronavirus disease 2019 (COVID-19) pandemic.   Obstet Gynecol. 2020;136(1):37-41. doi:10.1097/AOG.0000000000003933 PubMedGoogle ScholarCrossref
10.
DeNicola  N , Grossman  D , Marko  K ,  et al.  Telehealth interventions to improve obstetric and gynecologic health outcomes: a systematic review.   Obstet Gynecol. 2020;135(2):371-382. doi:10.1097/AOG.0000000000003646 PubMedGoogle ScholarCrossref
11.
Bartholomew  ML , Soules  K , Church  K ,  et al.  Managing diabetes in pregnancy using cell phone/internet technology.   Clin Diabetes. 2015;33(4):169-174. doi:10.2337/diaclin.33.4.169 PubMedGoogle ScholarCrossref
12.
McKiever  ME , Cleary  EM , Schmauder  T ,  et al.  Unintended consequences of the transition to telehealth for pregnancies complicated by opioid use disorder during the coronavirus disease 2019 pandemic.   Am J Obstet Gynecol. 2020;223(5):770-772. doi:10.1016/j.ajog.2020.08.003 PubMedGoogle ScholarCrossref
13.
Peahl  AF , Powell  A , Berlin  H ,  et al.  Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic.   Am J Obstet Gynecol. 2020;S0002-9378(20)31180-7. doi:10.1016/j.ajog.2020.10.008PubMedGoogle Scholar
14.
Turrentine  M , Ramirez  M , Monga  M ,  et al.  Rapid deployment of a drive-through prenatal care model in response to the coronavirus disease 2019 (COVID-19) pandemic.   Obstet Gynecol. 2020;136(1):29-32. doi:10.1097/AOG.0000000000003923 PubMedGoogle ScholarCrossref
15.
Duzyj  CM , Thornburg  LL , Han  CS .  Practice modification for pandemics: a model for surge planning in obstetrics.   Obstet Gynecol. 2020;136(2):237-251. doi:10.1097/AOG.0000000000004004 PubMedGoogle ScholarCrossref
16.
Jeganathan  S , Prasannan  L , Blitz  MJ , Vohra  N , Rochelson  B , Meirowitz  N .  Adherence and acceptability of telehealth appointments for high-risk obstetrical patients during the coronavirus disease 2019 pandemic.   Am J Obstet Gynecol MFM. 2020;2(4):100233. doi:10.1016/j.ajogmf.2020.100233 PubMedGoogle Scholar
17.
Lion  KC , Brown  JC , Ebel  BE ,  et al.  Effect of telephone vs video interpretation on parent comprehension, communication, and utilization in the pediatric emergency department: a randomized clinical trial.   JAMA Pediatr. 2015;169(12):1117-1125. doi:10.1001/jamapediatrics.2015.2630 PubMedGoogle ScholarCrossref
18.
Texas Medicaid provider procedures manual—November 2020. Accessed November 23, 2020. https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/archives/2020-11-TMPPM.pdf
19.
Burlone  S , Moore  L , Johnson  W .  Overcoming barriers to accessing obstetric care in underserved communities.   Obstet Gynecol. 2019;134(2):271-275. doi:10.1097/AOG.0000000000003364 PubMedGoogle ScholarCrossref
20.
Madden  N , Emeruwa  UN , Friedman  AM ,  et al.  Telehealth uptake into prenatal care and provider attitudes during the COVID-19 pandemic in New York City: a quantitative and qualitative analysis.   Am J Perinatol. 2020;37(10):1005-1014. doi:10.1055/s-0040-1712939 PubMedGoogle ScholarCrossref
21.
Futterman  I , Rosenfeld  E , Toaff  M ,  et al.  Addressing disparities in prenatal care via telehealth during COVID-19: prenatal satisfaction survey in East Harlem.   Am J Perinatol. 2021;38(1):88-92. doi:10.1055/s-0040-1718695PubMedGoogle ScholarCrossref
22.
Holcomb  D , Faucher  MA , Bouzid  J , Quint-Bouzid  M , Nelson  DB , Duryea  E .  Patient perspectives on audio-only virtual prenatal visits amidst the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.   Obstet Gynecol. 2020;136(2):317-322. doi:10.1097/AOG.0000000000004026 PubMedGoogle ScholarCrossref
23.
World Health Organization, ed.  WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. World Health Organization; 2016.
24.
Stowe  J , Smith  H , Thurland  K , Ramsay  ME , Andrews  N , Ladhani  SN .  Stillbirths during the COVID-19 pandemic in England, April-June 2020.   JAMA. 2021;325(1):86-87. doi:10.1001/jama.2020.21369 PubMedGoogle ScholarCrossref
25.
Butler Tobah  YS , LeBlanc  A , Branda  ME ,  et al.  Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring.   Am J Obstet Gynecol. 2019;221(6):638.e1-638.e8. doi:10.1016/j.ajog.2019.06.034 PubMedGoogle ScholarCrossref
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